Thursday, October 06, 2005

Bird Flu Review

H5N1 - One of the Bird Flu Virus Strains - Is It Mutating?
"If [Bush] doesn't believe in evolution, than he shouldn't be the least bit worried about a new kind of bird flu or HIV, for that matter."
-- Richard Leakey
It's still back-page stuff in most newspapers, but the bird flu virus suddenly seems to be scaring the bejesus out of world leaders.


The "highly pathogenic" H5N1 virus "was first identified in Italy more than 100 years ago." A new outbreak in poultry began in Southeast Asia in mid-2003.

According to the UN's World Health Organization (WHO) the recent outbreaks are "historically unprecedented in their geographical size and the number of birds affected." To date, at least 60 humans have died in four Asian countries, all apparently from direct contact with infected birds.

There are no reliable reports, yet, of human-to-human infection -- except perhaps for a few "one-off" incidents -- but that's what everyone is worrying about. As of February 2005, humans who were infected suffered a fatality rate as high as 70 percent.

"Great" Pandemic Risk

WHO considers the present risk of a bird flu worldwide epidemic "great" but also "unpredictable" in timing and severity. Says the WHO:
All conditions for the start of a pandemic have been met save one: changes in the virus that would make it contagious among humans, thus allowing easy and sustainable human-to-human transmission. The likelihood that this will happen is a matter of opportunity and probability.
The reason for this, as a report late yesterday in the Washington Post says, is that "the strain of avian influenza that has led to the deaths of 140 million birds and 60 people in Asia in the past two years appears to be slowly acquiring the genetic changes characteristic of the 'Spanish flu' virus that killed 50 million people nearly a century ago."

Indeed, recent laboratory analysis shows that the 1918 Spanish Flu virus and the new bird flu virus have always had "structural" similarities. Modern research on the 1918 virus, which was found in frozen graves in Alaska, establishes that the Spanish Flu virus at some point "changed to make it capable of attaching to human cells, thus allowing human-to-human transmission."

Sounding the Alarm

Rather suddenly, national and world political leaders are beginning to echo the same alarm health scientists have been banging at for more than two years. Here's a rundown of recent news over just the past week:
  • Last Friday BBC News interviewed Dr. David Nabarro, the newly appointed influenza coordinator for the UN's World Health Organization (WHO). He warned that if the bird flu virus were to mutate in such a way as to become communicable by humans, as the Spanish Flu virus did, it would "kill between 5 and 150 million people" world wide. He added the liklihood of such a mutation was "high" and that the result would threaten not only massive deaths but worldwide disruptions in daily life.

  • A few hours later, the Associated Press and other wire services reported that a WHO press spokesman in Geneva "made a surprise appearance" at a press briefing for the purpose of 'dampening' fears ignited by Nabarro's interview. But get this: "While he did not say the 150 million prediction was wrong, or even implausible, he reiterated that WHO considers a maximum death toll of 7.4 million a more reasoned forecast." Great 'dampening' job, there.

  • The spokeman's 'dampening' doesn't seem to have slowed Nabarro down. A few days later, he told Canadian TV News, "A flu pandemic could fundamentally alter the world as we know it."

  • The New York Times also reported on Wednesday that a week earlier a "closed-door briefing" of senators and congressmen was held in Washington D.C. and it sparked "fear of an outbreak" that was now sweeping "official Washington." One day later, "the Senate squeezed $3.9 billion for flu preparations into a Pentagon appropriations bill."

  • Hours later, a Reuters news dispatch estimated that flu vaccines on hand would cover "less than one percent" of the U.S. population.

  • On Thursday, Moscow time, Dmitry Lvov of the Russian Virology Institute told a virology conference there, "We are half a step away from a worldwide pandemic catastrophe." The Russian expert claimed that U.S. researchers possessed data suggesting that if a pandemic hits, "up to 700,000 Americans would fall ill" and he reasoned a comparable number would be infected in Russia. Given the current mortality rate of about 70 percent, Lvov said, "Up to one billion people could die around the whole world in six months."

  • Also late Wednesday, Democratic Senate minority leaders questioned whether the Bush administration was ignoring the need to make preparations now against a potential epidemic. The same senators are proposing a "Pandemic Preparedness and Response Act" which would enable the U.S. to "prepare for a pandemic by finalizing, implementing and funding pandemic preparedness and response plans."

  • Beginning today, the U.S. is hosting a 2-day 'avian flu' conference in Washington D.C. It's part of what appears to be a coordinated series of conferences throughout the world in countries like the U.K., Australia, Russia, China, Indonesia, and others.

Still Somnambulant

Not everyone in Washington is paying attention, however. Lorelei Kelly recounts today a telling incident that happened earlier this week as she was visiting a congressman's office:
I noticed the intern open a pack of wall posters from the Center for Technology and National Security Policy at National Defense University. They were handsome, instructive public health posters about how to recognize bird flu and what to do about it. My mom is a public health nurse, so I looked at them covetously and then watched with dismay as-- PLOP-- they went into the garbage can.
Meanwhile, in response to what appeared to be a planted question by a New York Post reporter, George Bush said in yesterday's Rose Garden press conference that he's been wondering, "If we had an outbreak somewhere in the United States ... how do you then enforce a quarantine?" Bush added, "One option is the use of a military that's able to plan and move."

The idea that we should let the military, on top of all its other duties, protect us from flu isn't sitting well with conservative or liberal commentators. It is even less popular with medical experts. Some may even start wondering why we have a Homeland Security Department at all, if it can't handle natural disasters or epidemic bio-hazards.

Others are worrying over the recurrent problem of incompetence in the Bush administration. The guy Bush put in charge of anti-flu activities, Stewart Simonson, looks like just another political crony from the same campaign pot as former FEMA director Michael Brown. At least one congressman noted he's also a liar who's been asleep at the switch:
At a House Government Reform hearing on July 14, 2005, Mr. Simonson claimed he had sufficient funds to purchase influenza vaccine and antiviral medication for the nation. The next day, his office submitted a funding request to Congress seeking an additional $150 million for flu vaccine and antiviral medication.
Science vs. Faith

On the scientific front, the New York Times reported Wednesday that two scientific teams have managed to synthesize the genetic sequence of the 1918 virus and have now compared it with the bird flu virus in Asia." The result: today's bird flu virus "shares some of the crucial genetic changes ... in the 1918 flu."

The scientists suspect that with "changes in just 25 to 30 out of about 4,400 amino acids in the virus" the bird flu would become "a killer."

The good news is that computer modeling reported two months ago shows that a pandemic could be contained with "a combination of carefully implemented public health measures introduced soon after the first cases appear." The bad news is that the several strains of bird flu virus are becoming more pathogenic and resistant to common anti-virals.

When mutations along the evolutionary line of a virus threaten nearly a quarter of the world's population, it probably isn't a good time to be fooling around with 'intelligent design' nonsense, which as yesterday's testimony in Pennsylvania demonstrates is merely an eleventh-hour editor's synonym for creationism. Surrendering to old myths and wishful thinking isn't going to prevent a pandemic.

As famed anthropologist Richard Leakey said recently:
"Anyone who believes in intelligent design cannot be that intelligent. Your Mr. Bush appears to believe in it. If he doesn't believe in evolution, than he shouldn't be the least bit worried about a new kind of bird flu or HIV, for that matter."
Partly because we can't be sure which of the several bird flu viruses might eventually mutate to cause a pandemic, we do not yet have a reliable vaccine to prevent avian flu, but in the U.S. laboratory experiments have begun. [Update: Earlier this week, Australia independently commenced human trials in the field of another bird flu vaccine developed there.]

In the meantime, the Center for Disease Control is recommending the usual precautions including vaccination of the elderly and children with this year's vaccine against the more common and less lethal human flu strain expected in the coming few weeks and months, plus treatment of infected victims with known anti-virals -- which have been allowed to lapse into short supply.

There is one more modest piece of good news. As the Atlanta Journal reports, Senator Tom Harkin (D-Iowa) "persuaded his Senate colleagues last week to add $4 billion to an unrelated appropriation measure to pay for stockpiling millions of doses of the antiviral medicine Tamiflu. But the final appropriation still awaits action by a Senate-House conference committee."

Good for Harkin. As that old soldier's adage might have it, "Pray if you must, but pass the appropriation."

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